Common Fertility Surgery May Offer Little Benefit Over Waiting

For years, women diagnosed with a septate uterus—a condition where a wall of tissue divides the womb—have been offered hysteroscopic septum resection. This surgical procedure restores the anatomy of the uterus and was widely believed to reduce risks of subfertility and miscarriage. However, a recent Cochrane review suggests this intervention may not deliver the expected reproductive benefits.

Analysing data from a randomised controlled trial (RCT) and 12 non-randomised studies, researchers compared the outcomes of surgery against ‘expectant management’, or simply waiting. The RCT evidence indicates that septum resection may result in little to no difference in live birth rates, ongoing pregnancy, or clinical pregnancy. Furthermore, the surgery is not without peril; reported complications included uterine perforation and cases where the septum was not fully removed.

The review authors noted that the certainty of the evidence is currently low to very low. Consequently, while the procedure successfully changes the anatomy, it remains uncertain whether it actually improves the odds of a healthy delivery compared to leaving the condition alone.